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Q&A: Assessing Oregon's Reinvention Of Medicaid

The Oregon Health Authority released the first full year report Tuesday on how the new Coordinated Care Organizations are doing. Reporter Kristian Foden-Vencil will be digging through it during the day. After a quick look, he joined OPB’s Geoff Norcross in the studio.

Geoff Norcross: Kristian, good morning.

Kristian Foden-Vencil: Good Morning.

GN: These Coordinated Care Organizations were created to change the way the Oregon Health Plan pays for care. So instead of paying a doctor every time a patient needs a service, the CCO is given this big sum to treat a whole population of patients. Correct?

KFV: Yup.That’s basically right. The idea is to change the incentives - from getting more money for providing more service, you know, to getting more money for keeping that whole population healthier. And that’s the way they can do it, by doing that global budget.

GN: So this report measures the 15 CCOs in 17 different ways. How did they do it?

KFV:Well, basically they look at things like emergency room visits, injections, innoculations, all of these 17 different ways. Like any big report of this nature there’s some good news and some bad news. For example, emergency room visits are down - which saves a lot of money - and primary care visits are up, basically meaning people are going to their doctors to get care, rather than waiting until the last minute and ending up in the ER. So that’s the good news. On the other hand, screening for things like chlamydia and cervical cancer were down across the board—which was the exact opposite of the targets. Lori Coyner with the Oregon Health Authority was was asked why that might have been.

Lori Coyner: Some of this could be the result of new guidelines that were set out nationally by the U.S. preventive services task force in 2012 for cervical cancer screening, that for many women would increase their screening rate to every five years from every three. There may also be some issues around the way that payment occurs now that we’re moving towards paying for improved outcomes. … Internally we’re going to be looking at the data and then presenting it to the CCOs to have further discussions about why that might be occurring.

KFV: So there’s a lot more to this report and I’m going to have to dig through it to find out more.

GN: What does it mean for the future of this model, for CCOs?

KFV: Basically, they’ve looked at these 17 points. These benchmarks were all figured out in 2011, so a few years ago. they are comparing last year - 2013 data with those 2011 data, to how much they improved. If they improved, like 15 of these did improve, 2 percent of their money was held back during the year. They’ll get that money back, the 15 that improved. Now that benchmark moves up. So the 2013 data, that’s this data we’re looking at now, that’s what next year’s data will be compared to. They’ll have to improve again. That’s the idea. Generally, push up, push up, push up.

GN: OK, and we’ll hear much more about this, I’m sure, in the hours to come. That’s OPB’s Kristian Foden-Vencil. Thanks so much for this update.